Provider Demographics
NPI:1447853585
Name:LIVE WELL ADJUSTED, P.A.
Entity type:Organization
Organization Name:LIVE WELL ADJUSTED, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-261-5020
Mailing Address - Street 1:7803 AFTON RD STE 2
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-1507
Mailing Address - Country:US
Mailing Address - Phone:651-261-5020
Mailing Address - Fax:
Practice Address - Street 1:7803 AFTON RD STE 2
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-1507
Practice Address - Country:US
Practice Address - Phone:651-261-5020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-20
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN7096887OtherMINNESOTA REGISTRATION